Mirror, mirror, on the wall, whose local care is fairest of all?

Cookson, R. Quality Watch. Published online: 31 October 2016

The problem with national data on health equity is that nobody owns it. It isn’t any one person’s problem, and it is easy to explain away bad news. Social inequalities in health and health care are influenced by all sorts of complex social, economic and technological factors, and there is no ‘national control group’ telling us what would have happened if national policy had been different. So it is hard to tell whether particular NHS policies are responsible for particular national equity trends. Policy makers are thus able to take credit for good news, and shift blame for bad news, without anyone learning any useful lessons.

Inequality gradients

Local equity is assessed by comparing the level of local inequality with the national picture and with ten similar CCG areas based on deprivation, age profile, ethnic mix and rurality. The diagrams below illustrate this for two CCGs in 2015. In the diagrams, each dot is a neighbourhood, with bigger dots for bigger neighbourhoods. The lines are linear regression lines through the dots, showing social inequality ‘gradients’ – the steeper the gradient, the greater the health inequality. The solid green line shows local inequality, as compared with the dashed red line showing national inequality and the dotted blue line showing inequality within ten similar CCG areas.

Liverpool:

Liverpool health equity gradient 600px

Brent:

Brent health equity gradient 600px

From the diagrams we can see that Liverpool has statistically significantly ‘worse-than-expected’ equity compared with these benchmarks, whereas Brent has significantly ‘better-than-expected’ equity.

Read the full blog post here

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